Loma Linda University, Department of Pediatric Urology, Loma Linda, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA.
McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada.
J Pediatr Urol. 2022 Jun;18(3):363.e1-363.e7. doi: 10.1016/j.jpurol.2022.03.027. Epub 2022 Apr 13.
Prenatal hydronephrosis (PNH) is one of the most common congenital anomalies and can increase the risk of developing a urinary tract infection (UTI) in the first two years of life. Continuous antibiotic prophylaxis (CAP) has been recommended empirically to prevent UTI in children with PNH, but its use has been controversial.
We describe the incidence of UTI in children with isolated PNH of the renal pelvis without ureteral dilation. Our objective was to compare patients receiving and not receiving CAP and determine whether CAP is beneficial at preventing UTI in children with isolated PNH.
Children with confirmed PNH were enrolled between 2008 and 2020 into the Society for Fetal Urology Hydronephrosis Registry. Children with isolated dilation of the renal pelvis without ureteral or bladder abnormality were included. The primary outcome was development of a UTI, comparing patients who were prescribed and not prescribed CAP.
In this cohort of 801 children, 76% were male, and 35% had high grade hydronephrosis (SFU grades 3-4). CAP was prescribed in 34% of children. The UTI rate among all children with isolated PNH was 4.2%. Independent predictors of UTI were female sex (HR = 13, 95% CI: 3.8-40, p = 0.0001), intact prepuce (HR = 5.1, 95% CI: 1.4-18, p = 0.01) and high grade hydronephrosis (HR = 2.0, 95% CI: 0.99-4.0, p = 0.05; Table) on multivariable analysis. For patients on CAP, the UTI rate was 4.0% compared to 4.3% without CAP (p = 0.76). The risk of UTI during follow-up was not significantly different between patients who received CAP and patients who were not exposed to CAP; adjusting for sex, circumcision status and hydronephrosis grade (HR = 0.72, 95% CI: 0.34-1.5, p = 0.38). In sub-group analysis of patients at higher risk of UTI (uncircumcised males, females and high grade hydronephrosis), CAP use was not associated with a statistically significant reduction in UTI.
The overall UTI rate in children with isolated PNH is very low at 4.2%. In the overall population of patients with isolated PNH, CAP was not associated with reduction in UTI risk, although the limitations in our study make characterizing CAP effectiveness difficult. Clinicians should consider risk factors prior to placing all patients with isolated PNH on CAP.
产前肾积水（PNH）是最常见的先天性异常之一，可增加儿童在生命的头两年发生尿路感染（UTI）的风险。经验性推荐连续使用抗生素预防（CAP）来预防 PNH 患儿的 UTI，但这种方法的应用一直存在争议。
我们描述了肾盂无输尿管扩张孤立性 PNH 患儿 UTI 的发生率。我们的目的是比较接受和未接受 CAP 治疗的患者，并确定 CAP 是否有益于预防孤立性 PNH 患儿的 UTI。
2008 年至 2020 年间，在胎儿泌尿外科学会肾积水登记处纳入确诊为 PNH 的患儿。纳入肾盂单纯扩张而无输尿管或膀胱异常的患儿。主要结局是发生 UTI，比较接受和未接受 CAP 治疗的患儿。
在这组 801 名患儿中，76%为男性，35%存在重度肾积水（SFU 分级 3-4 级）。34%的患儿接受了 CAP 治疗。所有孤立性 PNH 患儿的 UTI 发生率为 4.2%。UTI 的独立预测因素为女性（HR 为 13，95%CI：3.8-40，p=0.0001）、完整的包皮（HR 为 5.1，95%CI：1.4-18，p=0.01）和重度肾积水（HR 为 2.0，95%CI：0.99-4.0，p=0.05；表）。在多变量分析中，接受 CAP 治疗的患儿 UTI 发生率为 4.0%，而未接受 CAP 治疗的患儿 UTI 发生率为 4.3%（p=0.76）。在接受 CAP 治疗的患儿和未接受 CAP 治疗的患儿之间，随访期间 UTI 的风险无显著差异；调整性别、包皮环切状态和肾积水分级后（HR 为 0.72，95%CI：0.34-1.5，p=0.38）。在 UTI 风险较高的患儿（未行包皮环切术的男性、女性和重度肾积水）亚组分析中，CAP 的使用与 UTI 发生率的显著降低无关。
孤立性 PNH 患儿的总体 UTI 发生率非常低，为 4.2%。在孤立性 PNH 患儿的总体人群中，CAP 并未降低 UTI 风险，但本研究的局限性使得 CAP 有效性难以确定。临床医生应在为所有孤立性 PNH 患儿使用 CAP 前考虑风险因素。
